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Are Telestroke’s Virtual Diagnoses Accurate?

Telestroke (TS) is the technology that allows neurologists to treat people who have had strokes in many different locations—expanding the reach of a doctor’s expertise. TS networks are standard in many areas of the world and have become the most prevalent form of teleneurology. In the hyperacute context of stroke protocols, teleneurologists are asked to differentiate between stroke and stroke mimics (other medical conditions that have the similar symptoms as strokes). Stroke mimics are commonly encountered and are approximately one-third of all encounters. Yet, despite the continual development of TS for over 20 years, whether this platform can accurately distinguish between stroke and its mimics is unknown.

At the University of Utah, we had the opportunity to assess this question as we are a “hub” site and provide TS service to several smaller “spoke” hospitals. This is done through two-way video conferencing with doctors and patients at distant hospitals.

Global communication
Telestroke Map

From 2017 to 2018, we had 27 spoke hospitals. In a retrospective chart review study, we compared each patient’s final diagnosis made by the discharging physician to the diagnosis made by our vascular neurologists on initial TS evaluation. Ultimately, we were able to include 404 cases in our analysis. Of these, 56% had a TS diagnosis of stroke or transient ischemic attack and 44% had a diagnosis of stroke mimic. We found a strong agreement between the diagnosis at TS consultation compared to the final diagnosis for stroke and stroke mimics, meaning that the stroke-mimic diagnosis made by the TS consultant was highly likely to remain the same diagnosis later in the hospital course.

This convergence between the diagnoses of TS consultations and the discharge diagnoses suggests that TS systems can accurately assess a wide variety of patients with acute neurologic syndromes other than acute ischemic attacks.

While this project was initiated prior to the COVID-19 public health emergency, with the pandemic, the accuracy of teleneurology has become highly relevant to modern neurological care. Thus, this work serves as a validation of teleneurology well beyond the diagnosis of stroke and suggests future research and treatment avenues for this exciting new practice.

Read the full study here.